Bunion with Stiff and Painful Toe Joint

With a more advanced bunion, there is often pain and a decrease of motion of the first metatarsophalangeal joint (1st MPJ) or bunion joint. This type of pain is generally felt within the joint rather than on the surface. Normally the range of motion of the 1st MPJ is about 60 degrees. With an advanced bunion, (often called a hallux limitus), there can be as little as no motion in the joint. Frequently there is significant arthritis associated with the 1st MP joint, which is clearly visible on x-ray.  In addition to the arthritis, there may be dislocation of the 1st MPJ.

There are several causes of hallux limitus. Due to age, there may be a  gradual deterioration of the joint. There could be a history of trauma to the foot or joint.  Old sports injuries could have initiated this type of problem.

Different grades of the deformity exist from mild to severe, with the amount of joint motion typically decreasing over time. Patients usually exhibit pronated or flat feet during gait and stance.

Orthotics are an important conservative therapy because they can help control the abnormal pronatory forces that are created during walking. Orthotics can serve as an alternative treatment to surgery during the early stages. They also can act as a postoperative tool to limit the biomechanical influences that caused hallux limitus, thus reducing the chance of reoccurrence of symptoms.

Surgical Options

When the conservative option of using orthotics is ineffective, then surgery should be considered. The surgical procedure consists of a specialized bunionectomy procedure, where the abnormal and arthritic portion of bone of the bunion joint is removed and it is replaced by an implant or joint replacement (see picture below). The procedure is referred to as a "Bunionectomy with an Joint Replacement." If the bunion deformity is not as severe, or if there is little stiffness or joint pain, then the Angulated Bunionectomy is generally the better choice. The Bunionectomy with Joint Replacement procedure takes approximately 40 minutes, and can be performed as an outpatient.  Patients can walk on the foot, using a special surgical shoe, immediately after the surgery, without crutches, walkers or a cast.  Time Line for Bunion Surgery will provide additional details. If you wish to see the actual intra-operative photographs of this procedure, please request the URL by sending us an e-mail.

This is a photograph of the Futura joint replacement. It is available in a variety of sizes, depending upon the size of the foot. The upper and lower "stems" of the implant fit inside the metatarsal and great toe bones. The hinge part of the implant is positioned between the metatarsal and toe bones.

 

A side view of the bunion joint area before the procedure. Notice the two vertical lines drawn on both sides of the joint.

 

 

 

The section of the worn or degenerated joint has been removed.

 

 

 

 

View from the top of the foot with the Futura Primus joint replacement positioned in the joint space.  No screws or cement is used in this procedure.

 

 

 

 

 

Side view of Figure 4.  Notice the angled positions of the stems within the bones. These angled stems improve the function of the joint.

 

 

 

This pre-operative x-ray of a left foot shows the severe bunion "B" and the great toe "T" pushing against and causing a hammertoe "HT" of the adjacent 2nd toe. Note the dislocation "D" of the joint, as it is almost "falling off" the side of the bone.

 

 

 

 

 

 

This post-operative x-ray of the above left foot, shows the results of the surgery. The implant or joint replacement "I"  is positioned at the old location of the dislocation. The bunion "B" is removed, and the great toe "T" is now straight. In addition, the 2nd hammertoe "HT" is corrected and straight.

 

 

 

 

 

This is the surgical shoe that is worn for two weeks after the surgery.  Casting is not required.  Crutches, canes or walkers are rarely used.

 

 

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